Bone plate

ABSTRACT

Variable angle holes in bone plates structured to facilitate the formation of axial compression or tension of a bone, or which can assist in bone distraction. The variable angle hole can extend about a central axis and includes an inwardly extending wedge wall. The variable angle hole can be sized to receive insertion of a fixation element at a location at which a central longitudinal axis of the fixation element is axially offset from the central axis of the variable angle hole by an offset distance at least when the fixation element is initially driven into bone at least in a transverse direction. The wedge wall can be configured to be engaged by a portion of the fixation element in a manner that axially displaces at least one of the bone plate, the fixation element, and/or bone(s) in a direction that can generally reduce or increase the offset distance.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of pending U.S. application Ser. No.17/222,503, filed Apr. 5, 2021, which application is a continuation ofU.S. application Ser. No. 15/758,207, filed Mar. 7, 2018, now U.S. Pat.No. 10,993,750, issued May 4, 2021, which is a United States NationalPhase filing of International Application No. PCT/US2016/051864, filedSep. 15, 2016, which claims the benefit of U.S. Provisional ApplicationNo. 62/220,562, filed on Sep. 18, 2015. The disclosure of eachapplication is incorporated by reference in its entirety.

BACKGROUND

Embodiments of the present invention generally relate to variable angleholes in bone plates. More particularly, but not exclusively,embodiments of the present invention relate to variable angle holes inbone plates that are structured to facilitate the formation of axialcompression or tension in a bone.

The treatment of at least certain types of bone fractures often includessecuring a bone plate against the bone and across at least a portion ofthe fracture. Such bone plates, which can at least improve fracturestability, can be transversally compressed against the bone through theuse of one or more fixation elements such as, for example, screws, thatenter into the bone at relatively precise locations along the boneplate. Yet, axial compression or distraction of bones typically requiresan additional, separate plate that is also attached to the bone byfixation elements. However, such an additional, separate plate is oftengenerally bulky in size and occupies additional space in the surgicaltray. Further, the apertures in such additional plates are often sizedor structured in a manner that can compromise the strength of the boneplate.

BRIEF SUMMARY

Certain embodiments of the invention may include a bone plate configuredto receive the insertion of one or more fixation devices that secure thebone plate to one or more bone segments. The bone plate includes a firstend and a second end and axially extends between the first and secondends along a central longitudinal axis of the bone plate and at leastone variable angle hole. The at least one variable angle hole includes awedge wall and at least one axial offset recess, the axial offset recessbeing elongated along at least the central longitudinal axis and sizedto receive insertion of at least a portion of one of the fixationelements at a location in the at least one variable angle hole at whicha central axis of the received fixation element is at least axiallyoffset by an offset distance from a central longitudinal axis of the atleast one variable angle hole. The wedge wall can have a shape that isconfigured to be engaged by at least a portion of the fixation elementto axially displace at least one of the bone plate and the received bonesegment in a direction that decreases the offset distance between thecentral axis of the received fixation element and the centrallongitudinal axis of the at least one variable angle hole.

Additionally, certain embodiments of the invention may include anapparatus that includes a bone plate having a top side and a bottom sideand a variable angle hole positioned along the bone plate. The variableangle hole can have a wedge wall that inwardly extends from top side ofthe bone plate toward a central axis of the variable angle hole. Thevariable angle hole can be sized to receive insertion of a fixationelement at a location at which a central longitudinal axis of thefixation element is axially offset from the central axis by an offsetdistance at least when the fixation element is initially driven into abone at least in a transverse direction. Further, the wedge wall can beconfigured to be engaged by a portion of the fixation element in amanner that axially displaces at least one of the bone plate and thefixation element in a direction that reduces the offset distance.

Certain embodiments of the invention may also include a bone plateconfigured to receive insertion of one or more fixation devices thatsecure the bone plate to one or more bone segments. The bone plateincludes a top surface and a bottom surface on opposing sides of thebone plate, the bone plate axially extending between a first end and asecond end of the bone plate along a central longitudinal axis of thebone plate. The bone plate further includes at least one fixed-variableangle hole that extends through the bone plate. The at least onefixed-variable angle hole has an inner wall that defines an orifice.Additionally, the at least one fixed-variable angle includes a pluralityof recesses that are sized and shaped to receive insertion of at least aportion of a fixation element of the one or more fixation elements intothe at least one fixed-variable angle hole in a plurality oforientations that are non-parallel to a central axis of the at least onefixed-variable angle hole. Further, the at least one fixed-variableangle hole includes a plurality of projections that inwardly extend fromthe inner wall that are structured to lockingly engage a threadedportion of a head portion of the received fixation element when thereceived fixation element is positioned in the fixed-variable angle holeat an orientation that is generally parallel to the central axis of theat least one fixed-variable angle hole.

BRIEF DESCRIPTION OF THE DRAWINGS

The description herein makes reference to the accompanying figureswherein like reference numerals refer to like parts throughout theseveral views.

FIG. 1A illustrates a top view of a bone plate having variable anglelocking holes structured to at least assist in facilitating axialcompression and/or distraction of a bone fracture site.

FIG. 1B illustrates a cross sectional view of a variable angle lockinghole taken along line A-A of FIG. 1A.

FIG. 2 illustrates exemplary fixation of a bone plate to a fracture sitealong a bone using a fixation element that is positioned at an offsetlocation relative to a central axis of a receiving variable anglelocking hole of the bone plate.

FIG. 3 illustrates exemplary axial compression of a bone in whichmultiple fixation elements are driven into the bone at offset locationsin variable angle locking holes of a bone plate.

FIGS. 4A-4C illustrate different stages of engagement between a fixationelement that is being driven into a bone and a variable angle lockinghole of a bone plate that is configured to at least assist infacilitating axial compression and/or distraction of a bone fracturesite.

FIG. 5 illustrates a top view of a bone plate having variable anglelocking holes structured to at least assist in facilitating axialcompression and/or distraction of a bone fracture.

FIG. 6A illustrates a top view of an exemplary embodiment of a variableangle locking hole for a bone plate that is structured to at leastassist in facilitating axial compression and/or distraction of a bonefracture site.

FIG. 6B illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 6A taken along line D-D and positioned within a boneplate.

FIG. 6C illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 6A taken along line E-E and positioned within a boneplate.

FIG. 6D illustrates a top side perspective view of the variable anglelocking hole shown in FIG. 6A positioned within a bone plate.

FIGS. 7A and 7B illustrate top and bottom side views, respectively, ofan exemplary embodiment of a variable angle locking hole for a boneplate that is structured to at least assist in facilitating axialcompression and/or distraction of a bone fracture site.

FIG. 7C illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 7A taken along line D-D and positioned within a boneplate.

FIG. 7D illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 7A taken along line E-E and positioned within a boneplate.

FIG. 7E illustrates a top side perspective view of the variable anglelocking hole shown in FIG. 7A positioned within a bone plate.

FIGS. 8A and 8B illustrate top and bottom side views, respectively, ofan exemplary embodiment of a variable angle locking hole for a boneplate that is structured to at least assist in facilitating axialcompression and/or distraction of a bone fracture site.

FIG. 8C illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 8A taken along line D-D and positioned within a boneplate.

FIG. 8D illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 8A taken along line E-E and positioned within a boneplate.

FIG. 8E illustrates a cross sectional view of the variable angle lockinghole shown in FIG. 8A taken along line G-G and positioned within a boneplate.

FIG. 8F illustrates a top side perspective view of the variable anglelocking hole shown in FIG. 8A positioned within a bone plate.

FIG. 9A illustrates a top side perspective view of a bone plate havingboth static variable angle locking holes and a variable angle lockinghole having a compression slot.

FIGS. 9B and 9C illustrate top side perspective and top side views,respectively, of the variable angle locking hole having a compressionslot, as shown in FIG. 9A, that includes a pair of compression ramps.

FIG. 10A illustrates a top side perspective view of an exemplaryembodiment of a combination fixed-variable angle locking hole that isadapted for engagement with a locking fixation element in connectionwith a bone plate that accommodates axial compression and/or distractionof a bone fracture site.

FIG. 10B is a cross sectional view of a combination fixed-variable anglelocking hole taken along line A-A of FIG. 10A.

The foregoing summary, as well as the following detailed description ofcertain embodiments of the present invention, will be better understoodwhen read in conjunction with the appended drawings. For the purpose ofillustrating the invention, there is shown in the drawings, certainembodiments. It should be understood, however, that the presentinvention is not limited to the arrangements and instrumentalities shownin the attached drawings.

DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

Certain terminology is used in the foregoing description for convenienceand is not intended to be limiting. Words such as “upper,” “lower,”“top,” “bottom,” “first,” and “second” designate directions in thedrawings to which reference is made. This terminology includes the wordsspecifically noted above, derivatives thereof, and words of similarimport. Additionally, the words “a” and “one” are defined as includingone or more of the referenced item unless specifically noted. The phrase“at least one of” followed by a list of two or more items, such as “A, Bor C,” means any individual one of A, B or C, as well as any combinationthereof.

FIGS. 1A and 1B illustrate a top view and a cross sectional view,respectively, of an exemplary bone plate 100 having a plurality ofvariable angle locking holes 102 that are structured to at least assistin facilitating axial compression of a fracture site 104 (FIG. 2 )and/or distraction of a bone(s) 106 a, 106 b (FIG. 2 ). The bone plate100 can include opposite top and bottom sides 108, 110, as well asopposite first and second ends 112, 114. Further, the bone plate 100 canhave a variety of different shapes and sizes. For example, according tocertain embodiments, one or more sections of the bone plate 100 can havecontours or curves that generally correspond to similar contours orcurves of a portion of the bone 106 against which the bottom side 110 ofthe bone plate 100 can abut or otherwise be located at an adjacentposition. In the illustrated embodiment, the bone plate 100 can extendbetween the first and second ends 112, 114 along a central longitudinalaxis 116 of the bone plate 100. Further, the bone plate 100 can beconstructed from a variety of materials, including, for example,stainless steel, titanium, polymers, and/or ceramics, among othermaterials.

The bone plate 100 can include one or more variable angle locking holes102, among other static locking or non-locking holes and/or apertures inthe bone plate 100. At least a portion of the variable angle lockingholes 102 can extend from the top side 108 to the bottom side 110 of thebone plate 100 along a central axis 118 of each of the variable anglelocking holes 102 as shown, for example, in FIG. 1B. As shown in FIGS.1A and 1B, the variable angle locking holes 102 can include one or moreramps or wedge walls 120 that extend around at least a portion of anouter periphery of the variable angle locking hole 102 along the topside 108 of and into the bone plate 100. As discussed below, the wedgewall 120 can be configured to provide a wedge or ramp effect on at leastthe bone plate 100 when engaged by a fixation element such as, forexample, a screw that provides a force to axially displace, deform,and/or compress the bone plate 100 at least in a direction that can begenerally parallel to the central longitudinal axis 116 of the boneplate 100 and/or the adjacent bone 106. Further, according to certainembodiments, in addition to, or in lieu of, displacing, deforming,and/or compressing the bone plate 100, the wedge wall 120 can beconfigured to, when operably engaged with a fixation element, axiallydisplace, influence an axial position and/or assist in providing anaxial compressive force against one or more bones 106 or bone segments106 a, 106 b such as, for example, in connection with bring/retainingbones to a particular location for fracture repair or bone distraction.

According to the embodiment illustrated in FIGS. 1A and 1B, the variableangle locking hole 102 can include an inner wall 122 that generallydefines an orifice 124 of the variable angle locking hole 102. At leasta portion of the orifice 124 generally extends about the central axis118 of the variable angle locking hole 102 extending through the boneplate 100. The orifice 124 can have a variety of shapes and sizes, andcan be symmetrical or asymmetrical about the central axis 118.

Referring to FIGS. 1A and 1B, the orifice 124 can include a first axialoffset recess 126 a and a second axial offset recess 126 b, the firstand second axial offset recesses 126 a, 126 b being located on oppositesides of the orifice 124. Further, according to the illustratedembodiment, the first and second axial offset recesses 126 a, 126 b canhave elongated shapes that extend axially generally along the centralaxis 118. Moreover, the inner wall 122 along both the first and secondaxial offset recesses 126 a, 126 b can include a first wall segment 130a and an opposing second wall segment 130 b that are interconnected byan end wall segment 132. Further, according to certain embodiments, thecentral longitudinal axis 116 of the bone plate 100 can extend through aportion of the end wall segment 132 such as, for example, through amiddle section or region of the end wall segment 132. Referring to FIG.1A and FIG. 4A, in some embodiments, the first and second wall segments130 a, 130 b can be arranged generally parallel to one another. Further,according to the illustrated embodiment, the first and second wallsegments 130 a, 130 b can be arranged generally parallel to the centrallongitudinal axis 116. Additionally, the first and second wall segments130 a, 130 b can be separated from one another by a distance that isapproximately equal to or larger than a corresponding size, such as adiameter, of at least a threaded or non-threaded shank portion 134 ofthe fixation element 128 that is positioned adjacent to a head portion136 of the fixation element 128.

Referring to FIG. 1A, according to certain embodiments, the orifice 124can also include one or more angular positioning recesses 138 a, 138 b,or static angular positioning recesses, that is/are positioned about theorifice 124 between the first and second axial offset recesses 126 a,126 b. For example, according to the embodiment illustrated in FIG. 1A,the orifice 124 can include a first angular positioning recess 138 a anda second angular positioning recess 138 b, the first and second angularpositioning recesses 138 a, 138 b being positioned at or around amid-section of the inner wall 122 between the first and second axialoffset recesses 126 a, 126 b and on opposite sides of the centrallongitudinal axis 116. The angular positioning recesses 138 a, 138 b canbe configured to accommodate insertion of the fixation element 128 intothe orifice 124 at certain angles relative to the central axis 118 ofthe orifice 124. Thus, the angular positioning recesses 138 a, 138 b canextend the width or size of the orifice 124 in at least certaindirections so that a fixation element 128 can be inserted into thevariable angle locking hole 102 from the top side of the bone plate 100and through the variable angle locking hole 102 at the bottom side 110of the bone plate 100 at certain angles that are non-parallel to thecentral axis 118 of the variable angle locking hole 102.

As shown in FIG. 1A, according to certain embodiments, the angularpositioning recesses 138 a, 138 b can include a pair of convergingsidewalls 140 a, 140 b. Further, the width of the distance between thesidewalls 140 a, 140 b of the angular positioning recesses 138 a, 138 bcan generally be less than the distance between the first and secondwall segments 130 a, 130 b of each of the first and second axial offsetrecesses 126 a, 126 b. For example, according to the illustratedembodiment, the largest distance between the sidewalls 140 a, 140 b ofthe angular positioning recesses 138 a, 138 b such as, for example, at amouth portion 142 of the angular positioning recesses 138 a, 138 b atwhich the sidewalls 140 a, 140 b can begin to extend in convergingdirections, can be smaller than the distance between opposing first andsecond wall segments 130 a, 130 b of the orifice 124.

The first and second axial offset recesses 126 a, 126 b can be separatedfrom adjacent angular positioning recesses 138 a, 138 b by one or moretabs 144. According to the illustrated embodiment, a side 146 a of oneor more of the tabs 144 can be generally defined by either the first orsecond wall segment 130 a, 130 b, and another side 146 b of the one ormore tabs 144 can be defined by one of the sidewalls 140 a, 140 b of theadjacent angular positioning recess 138. The tabs 144 can be sized suchthat, at least when a portion of the fixation element 128 extends intothe variable angle locking hole 102, a portion of the fixation element128 lockingly engages one or more of the tabs 144. For example,according to certain embodiments, a head portion 136 of the fixationelement 128, or another portion of the fixation element 128 that is inproximity to the head portion 136, can be threadingly engaged with ormate with corresponding portions of one or more sides 146 a, 146 b ofone or more of the tabs 144, including, but not limited to, threads orprotrusions that can be positioned along one or more sides of sides 146a, 146 b of the tabs 144. Further, the tabs 144 can be sized to provideinterference that prevents at least a portion of the fixation element128 such as, for example, the head portion 136, from being pulledentirely through the orifice 124.

According to certain embodiments, at least a portion of the wedge wall120 that can engage the fixation element 128 can have a shape and/ororientation that is arranged non-parallel and non-perpendicular to thecentral axis 118 of the variable angle locking hole 102. For example,referring to FIG. 1B, according to certain embodiments, the wedge wall120 can include an outer end 121 that extends inwardly toward a second,inner end 123, the outer end 121 being in closer proximity than theinner end 123 to the top side 108 of the bone plate 100, and the innerend 123 being in closer proximity than the outer end 121 to the centrallongitudinal axis 116 of the bone plate 100. For example, according tocertain embodiments, the wedge wall 120 can be one or more of an angled,tapered, inclined and/or curved surface that extends generally inwardlyand/or downwardly into the bone plate 100 from or around the top side108 of the bone plate 100. According to certain embodiments, anadditional first secondary wedge wall 120′ can be provided by a chamferor transition surface between the top side 108 of the bone plate 100 andthe wedge wall 120, and/or a second secondary wedge wall 120″ thatextends as a transition between the wedge wall 120 and the inner wall122 of the bone plate 100.

FIGS. 2 and 4A illustrate an example of a first fixation element 128 abeing driven generally in at least a transverse direction (as indicatedby the “T” direction in FIG. 4A) through a first axial offset recess 126a of a variable angle locking hole 102 a of a bone plate 100 and into abone 106 such as, for example, a bone 106 having a fracture site 104between a first bone segment 106 a and a second bone segment 106 b. Forpurposes of illustrating the examples depicted in FIGS. 2-4C, at least aportion of the bone plate 100 can already be secured to the first andsecond bone segments 106 a, 106 b via the implantation of other fixationelements (not shown) through other holes and/or other apertures in thebone plate 100. For example, according to certain embodiments, fixationelements can have previously been at least partially driven into thefirst and second bone segments 106 a, 106 b through other holes and/orapertures at or around opposing first and second ends 112, 114 of thebone plate 100 prior to the implantation of the first and secondfixation elements 128 a, 128 b (FIGS. 2-4C) into the bone 106.

As illustrated in FIGS. 2-4B, and as discussed above, according to theillustrated embodiment, the first and second axial offset recesses 126a, 126 b are sized to accommodate insertion of at least a portion of thefirst fixation element 128 a at locations that are offset from thecentral axis 118 a of the variable angle locking hole 102 a. Forexample, referring to FIGS. 2 and 4A, in the illustrated embodiment, thefirst fixation element 128 a can, as the fixation element 128 a is atleast initially being driven into the first bone segment 106 a, bepositioned at a location relative to the first axial offset recess 126 asuch that the central longitudinal axis 148 a of the first fixationelement 128 a is at least initially offset from and non-intersectingwith the central axis 118 a of the variable angle locking hole 102 a.Further, in the illustrated embodiment, in at least certain embodiments,at least the first axial offset recess 126 a can be sized and shapedsuch that the central longitudinal axis 148 a of the first fixationelement 128 a that extends into the first axial offset recess 126 a canbe arranged generally parallel to the central axis 118 a of the variableangle locking hole 102. However, according to other implantations orembodiments, the central longitudinal axis 148 a of the first fixationelement 128 a can be arranged non-parallel to the central longitudinalaxis 148 a as the first fixation element 128 a is at least initiallydriven into the first bone segment 106 a.

As the first fixation element 128 a in the illustrated embodimentproceeds to be driven into the first bone segment 106 a, at least aportion of the head portion 136 of the first fixation element 128 a cancome into contact with the wedge wall 120 of the variable angle lockinghole 102 a, as illustrated in FIGS. 2 and 4B. According to certainembodiments, a bottom surface 150 and/or edge surface 152 of the headportion 136 of the first fixation element 128 a can have a shape thatfacilitates axial displacement, such as sliding, and/or deformation ofat least a portion of the bone plate 100 in an axial direction (asindicated by the “A” direction in FIG. 4B) and/or facilitate axialdisplacement, positioning, and/or assist in providing an axialcompressive force against the bone 106 or bone segment(s) 106 a, 106 bas the first fixation element 128 a continues to be driven at least in atransverse direction into the first bone segment 106 a. For example,according to certain embodiments, the bottom and/or edge surfaces 150,152 of the head portion 136 can have a tapered or inclined shape thatcan generally mate with the shape of at least a portion of the wedgewall 120 of the variable angle locking hole 102 a so as to facilitate,for example, axial displacement of the bone plate 100 and/or bonesegment 106 a, and/or facilitate a compressive force against thefracture site 104.

According to such an embodiment, as the first fixation element 128 a,and more specifically the head portion 136 of the first fixation element128 a engages the wedge wall 120 of the variable angle locking hole 102a, the interaction between the first fixation element 128 a and thewedge wall 120 can result in a pulling or pushing force being exerted onthe bone plate 100 and/or bone 106 or bone segment(s) 106 a, 106 b thatseeks to axially displace the bone plate 100 and/or bone 106 or bonesegment(s) 106 a, 106 b in a manner that at least attempts to bring thecentral axis 118 of the variable angle locking hole 102 a into closerproximity to or alignment with the central longitudinal axis 148 a ofthe first fixation element 128 a. For example, according to theembodiment illustrated in FIG. 2 , the first fixation element 128 a canbe at least initially positioned in the first axial offset recess 126 aof the variable angle locking hole 102 a such that the head portion 136of the first fixation element 128 a can contact a portion of the wedgewall 120 that is in closer proximity to the first end 112 of the boneplate 100 than other portions of the wedge wall 120. Accordingly, as thefirst fixation element 128 a continues to be driven into the first bonesegment 106 a, engagement between the head portion 136 of the firstfixation element 128 a and the wedge wall 120 can result in a force thatattempts to at least axially displace the bone plate 100 generally inthe direction of the first end 112 of the bone plate 100. Further, suchengagement between the first fixation element 128 a and the wedge wall120 can seek to pull the first fixation element 128 a and the attachedfirst bone segment 106 a in an opposite direction, and more specificallyin a direction toward the second bone segment 106 b, the fracture site104, and/or the second end 114 of the bone plate 100.

In at least some embodiments, as the first fixation element 128 acontinues to be at least transversally driven toward a seated positionin the variable angle locking hole 102 a, as illustrated in FIGS. 3 and4C, the axial force generated by engagement between the head portion 136of the first fixation element 128 a and the wedge wall 120 can continueto axially displace at least the bone plate 100 and/or the first bonesegment 106 a in opposite directions until the central longitudinal axis148 of the fixation element 128 is generally aligned with the centralaxis 118 of the variable angle locking hole 102 a. Thus, in the presentembodiment, as the bone plate 100 and/or the first bone segment 106 ais/are axially displaced by engagement between the head portion 136 ofthe first fixation element 128 a and the wedge wall 120, the first axialoffset recess 126 a can be displaced relative to at least a portion ofthe first fixation element 128 a, such as the shank portion 134 and/orthe head portion 136 of the first fixation element 128 a, such that thecentral longitudinal axis 148 a of the first fixation element 128 a isgenerally aligned with the central axis 118 a of the variable anglelocking hole 10 a.

As illustrated in at least FIG. 4C, according to certain embodiments,the variable angle locking hole 102 a and/or the first fixation element128 a can be structured such that, at least when the first fixationelement 128 a approaches and/or reaches the seated position, the headportion 136 of the first fixation element 128 a is generally recessedbelow or positioned relatively flush with the top side 108 of the boneplate 100. For example, according to certain embodiments, the wedge wall120 can extend to a depth within the bone plate 100 beneath the top side108 of the bone plate 100 that is sized to accommodate placement of thehead portion 136 of the first fixation element 128 a such that the firstfixation element 128 a minimally extends, if at all, beyond the top side108 of the bone plate 100 when the first fixation element 128 a is atthe seated position.

FIG. 3 depicts an example of a second fixation element 128 b beingdriven into the second bone segment 106 b following the at least partialimplantation of the first fixation element 128 a in the first bonesegment 106 a. While, in the present example, the first fixation element128 a was at least initially positioned in at least a portion of thefirst axial offset recess 126 a, the second fixation element 128 b isshown as being at least initially positioned within at least a portionof the second axial offset recess 126 b of another variable anglelocking hole 102 b. Accordingly, during at least initial implantation,the central longitudinal axis 148 b of second fixation element 128 b inthe present example is offset to a side of the central axis 118 b of thevariable angle locking hole 102 b that is generally opposite the side towhich the central longitudinal axis 148 a of the first fixation element128 a had been offset relative to the central axis 118 a of thecorresponding variable angle locking hole 102 a, as illustrated in atleast FIGS. 2, 4A and 4B. Thus, as the second fixation element 128 b isdriven into the second bone segment 106 b, engagement between the headportion 136 of the second fixation element 128 b and the adjacentportion of the wedge wall 120 can generate a force(s) that seeks todisplace the bone plate 100 and/or the second bone segment 106 b inopposite directions that are generally opposite to the directions atwhich the engagement of the first fixation element 128 a and the wedgewall 120 sought to displace the bone plate 100 and/or the first bonesegment 106 a. For example, engagement between the head portion 136 ofthe second fixation element 128 b and the wedge wall 120 can generate aforce(s) that seeks to displace the bone plate 100 generally in thedirection of the second end 114 of the bone plate 100. Further, suchforces generated by engagement between the head portion 136 of thesecond fixation element 128 b and the wedge wall 120 can seek todisplace the second bone segment 106 b generally in a direction towardthe first end 112 of the bone plate 100, toward the fracture site 104,and/or toward the first bone segment 106 a.

In addition to forces that can generate displacement of the bone plate100, bone segments 106 a, 106 b, and/or bone 106, the forces generatedby the engagement between the wedge wall 120 and the fixationelements(s) 128 a, 128 b can be used to retain the relative axialposition(s) of bone segments 106 a, 106 b and/or the bone 106 and/orfacilitate an axially compressive force being exerted at least onto thebone 106 and/or bone segments 106 a, 106 b. For example, in the examplesillustrated in FIGS. 2-4C, besides providing forces that can displacethe bone segments 106 a, 106 b and/or bone plate 100, the forcesgenerated by engagement between the wedge wall 120 and the fixationelements(s) 128 a, 128 b can assist in providing compression or tensionto the fracture site 104. Further, while the preceding examples werediscussed with respect to bringing bone segments 106 a, 106 b togetherand/or providing compression or tension forces to the fracture site 104,for other situations, the first and second fixation elements 128 a, 128b can be at least initially positioned on opposite sides of theirrespective variable angle locking holes 102 a, 102 b so as to at leastassist in generating distraction, rather than compressive or tensionforces. For example, the first fixation element 128 a can be at leastinitially positioned in the second axial offset recess 126 b of theassociated variable angle locking hole 102 a, and the second fixationelement 128 b can be at least initially positioned in the first axialoffset recess 126 a of the associated variable angle locking hole 102 bso that the central longitudinal axes 148 a, 148 b of the first andsecond fixation devices 128 a, 128 b are each at least initiallypositioned between the fracture site 104 and the associated central axis118 of their respective variable angle locking hole 102 a, 102 b.According to such an embodiment, engagement of the head portion 136 ofeach of the first and second fixation elements 128 a, 128 b with theadjacent portion of the wedge wall 120 can provide forces that at leastassist in attempting to axially inwardly displace the bone plate 100toward the fracture site 104, and thereby displace the first and secondbone segments 106 a, 106 b in opposite directions and away from oneanother.

FIG. 5 illustrates another exemplary embodiment of a bone plate 160having variable angle locking holes 162. According to the depictedexemplary embodiment, the variable angle locking holes 162 include afirst axial offset recess 164 a, a second axial offset recess 164 b,four angular positioning recesses 164, and a ramp or wedge wall 174. Thefirst and second axial offset recesses 164 a, 164 b are positioned onopposite sides of the orifice 168 and generally extend in oppositedirections along a central longitudinal axis 170 of the bone plate 160.Further, the first and second axial offset recesses 164 a, 164 b aresized to accommodate placement of at least a portion of a fixationelement 128 therein and at locations that are offset from a central axis172 of the variable angle locking hole 162. Thus, similar to theembodiments and examples discussed above with respect to FIGS. 1-4C,engagement between a fixation element 128 that is at an offset positionrelative to the central axis 172 of the variable angle locking hole 162and the adjacent portion of the wedge wall 174 can at least assist inproviding a force that axially displaces the bone plate 160 and/or thebone 106 or one or more bone segments 106 a, 106 b.

Compared to the embodiments discussed above with respect to FIGS. 1-4C,the distance between the first and second wall segments 176 a, 176 b ofthe first and second axial offset recesses 164 a, 164 b in theembodiment illustrated in FIG. 5 have been reduced, and the first andsecond wall segments 176 a, 176 b are arranged non-parallel to oneanother such that the first and second wall segments 176 a, 176 b eachconverge in a direction toward the end wall segment 178. Such aconfiguration can increase the size of the tabs 180 that are positionedbetween the first and second wall segments 176 a, 176 b and the angularpositioning recesses 166, which can in turn increase the strength of thetabs 180. Moreover, by increasing the strength of the tabs 180, thestrength of the locking engagement between the tabs 180 and the fixationelement 128 can also be enhanced. Further, while the size of the firstand second axial offset recesses 164 a, 164 b can be decreased whencompared to the first and second axial offset recesses 126 a, 126 billustrated in at least FIG. 1 , the first and second axial offsetrecesses 164 a, 164 b illustrated in FIG. 5 can remain larger than theangular positioning recesses 166. For example, the distance between thefirst and second wall segments 176 a, 176 b of the first and secondaxial offset recesses 164 a, 164 b can be larger than a similar distancebetween opposing sidewalls 182 a, 182 b of the angular positioningrecesses 166.

FIGS. 6A-6D illustrate another exemplary embodiment of a bone plate 200having variable angle locking holes 202. As shown, the variable anglelocking holes 202 include a first axial offset recess 204 a and secondaxial offset recess 204 b, a first and a second angular positioningrecess 206 a, 206 b, and a ramp or wedge wall 208. Again, the first andsecond axial offset recesses 204 a, 204 b are positioned on opposingsides of the orifice 210 and generally extend in opposite directionsalong a central longitudinal axis 212 of the bone plate 200. Further, atleast the first and second axial offset recesses 204 a, 204 b are sizedto accommodate placement of at least a portion of a fixation element 128therein and at locations that are offset from a central axis 214 of thevariable angle locking hole 202. Thus, similar to the embodimentsdiscussed above with respect to FIGS. 1-5 , engagement between afixation element 128 that is at an offset position relative to thecentral axis 214 of the variable angle locking hole 202 and the adjacentportion of the wedge wall 208 can at least assist in providing a forcethat axially displaces the bone plate 200, the bone 106, and/or or oneor more bone segments 106 a, 106 b.

According to certain embodiments, the first and second angularpositioning recesses 206 a, 206 b can be positioned on opposite sides ofthe central longitudinal axis 212 of the bone plate 200. Further,according to certain embodiments, the first and second angularpositioning recesses 206 a, 206 b can have a size similar to that of thefirst axial offset recess 204 a and second axial offset recess 204 b.According to such an embodiment, the first and second angularpositioning recesses 206 a, 206 b can be sized and positioned such thatat least a portion of a fixation element can be positioned in the firstand/or second angular positioning recesses 206 a, 206 b such that thecentral longitudinal axis 148 of the fixation element 128 is offset fromthe central axis 214 of the variable angle locking hole 202. In suchsituations, engagement between the fixation element 128 and the wedgewall 208 can at least linearly adjust the position of the bone plate 200and/or associated bone 106 or bone segment 106 a, 106 b in a directionalong the outer surface of the bone 106 that is generally perpendicularto the central axis 214 of the variable angle locking hole 202 and whichis also non-parallel to the central longitudinal axis 212 of the boneplate 200. For example, in the illustrated embodiment, as the first andsecond angular positioning recesses 206 a, 206 b generally extend indirections that are perpendicular to the central longitudinal axis 212of the bone plate 200, engagement of a fixation element 128 against aportion of the wedge wall 208 that is adjacent to either of the first orsecond angular positioning recesses 206 a, 206 b can displace the boneplate 200, bone 106, or bone segment 106 a, 106 b in a direction that isgenerally perpendicular to the central longitudinal axis 212 of the boneplate 200.

The bone plate 200 illustrated in FIGS. 6A-6D further includes aplurality of layers of tabs 216 a, 216 b. More specifically, theillustrated bone plate 200 includes a first layer 218 a of one or moretabs 216 a and a second layer 218 b of one or more tabs 216 b. As shown,the first layer 218 a of tabs 216 a can be positioned closer than thesecond layer 218 b of tabs 216 b relative to the top side 220 of thebone plate 200, and the second layer 218 b of tabs 216 b can bepositioned closer than the first layer 218 a of tabs 216 a relative tothe bottom side 223 of the bone plate 200. Additionally, according tocertain embodiments, the first and second layers 218 a, 218 b of tabs216 a, 216 b can be angularly offset from one another about the variableangle locking hole 202. For example, in the illustrated embodiment, thefirst layer 218 a of tabs 216 a can comprise tabs 216 a that arepositioned in a manner that separates the first and second axial offsetrecesses 204 a, 204 b from the adjacent first and second angularpositioning recesses 206 a, 206 b. However, the second layer 218 b oftabs 216 b can comprise tabs 216 b that each extend into a least aportion of the space or area of the first and second axial offsetrecesses 204 a, 204 b and/or the space or area of the first and secondangular positioning recesses 206 a, 206 b, and can thus be located atpositions that are angularly offset from the locations of the tabs 216 aof the first layer 218 a. Inclusion of additional tabs 216 a, 216 b suchas, for example, via the second layer 218 b of tabs 216 b, can furtherenhance the strength of the locking engagement between the fixationelement 128 and the tabs 216 a, 216 b.

While the embodiments illustrated in FIGS. 6A-6D include four tabs 216a, 216 b in each of the first and second layers 218 a, 218 b, it shouldbe understood that the number of tabs 216 a, 216 b for each layer 218 a,218 b can vary. Further, the number of tabs 216 a in the first layer 218a can be different than the number of tabs 216 b in the second layer 218b. For example, FIGS. 7A-7E illustrate a bone plate 221 that includesvariable angle locking holes 222 having a first layer 218 c of tabs 216c that includes four tabs 216 c that generally separate the first andsecond axial offset recesses 204 c, 204 d from the first and secondangular positioning recesses 206 c, 206 d, and a second, lower layer 218d that includes two tabs 216 d, 216 d′. Further, although one of each ofthe two tabs 216 d, 216 d′ of the second layer 218 d is illustrated asbeing positioned in a space of the first and second angular positioningrecesses 206 c, 206 d, respectively, according to other embodiments, atleast one of the tabs 216 d, 216 d′ can be positioned in space of atleast one of the first and/or second axial offset recesses 204 c, 204 d.

FIGS. 8A-8F illustrate another embodiment of a bone plate 250 havingvariable angle locking holes 252 that include a ramp or wedge wall 254,opposite first and second axial offset recesses 256 a, 256 b, oppositefirst and second angular positioning recesses 258 a, 258 b, a firstlayer 260 a of tabs 262 a, and second layer 260 b of tabs 262 b.Further, the first layer 260 a has a number of tabs 262 a that isdifferent from the number of tabs 262 b of the second layer 260 b. Morespecifically, in the embodiment illustrated in FIGS. 8A-8F, the firstlayer 260 a has four tabs 262 a, while the second layer 260 bb has twotabs 26 b.

Further, as illustrated in at least FIGS. 8A, 8C and 8D, the wedge wall254 includes first and second compression ramps 264 a, 264 b that arepositioned in a portion of the wedge wall 254 that extends around thefirst axial offset recess 256 a and the second axial offset recess 256b, respectively. According to certain embodiments, the compression ramps264 a, 264 b can be configured as a recess or groove in the wedge wall254 that extends about at least a portion of the associated first andsecond axial offset recess 256 a, 256 b. Further, according to certainembodiments, the compression ramps 264 a, 264 b can have a shape or sizethat is generally similar to at least a portion of the fixation element128. For example, according to certain embodiments, the compressionramps 264 a, 264 b can have a size that accommodates the placement of aportion of the head portion 136 of the fixation element 128. Further,the compression ramps 264 a, 264 b can be configured to furtherfacilitate the linear compressive force exerted by the fixation element128 against the bone plate 250, and thereby further facilitate axialdisplacement of the bone plate 250 relative to at least the fixationelement 128 and/or axial displacement of the corresponding bone 106relative to the bone plate 250 and/or the formation of axiallycompressive or distraction forces.

The compression ramps 264 a, 264 b can include a wall portion 266 and aramp portion 268, with the wall portion 266 extending about at least aportion of the ramp portion 268 and positioned between the adjacentportion of the wedge wall 254 and the ramp portion 268. According tocertain embodiments, the wall portion 266 can extend in a generallyvertical direction. However, according to other embodiments, the wallportion 266 can be angled or sloped so as to provide a transitionbetween the wedge wall 254 and the lower or recessed ramp portion 268 ofthe compression ramps 264 a, 264 b. Further, according to certainembodiments, the ramp portion 268 can extend along an incline or slopethat is, or alternatively is not, similar to the incline or slope of theadjacent portion of the wedge wall 254.

FIGS. 9A-9C illustrate a bone plate 300 having one or more staticvariable angle locking holes 302 and at least one variable angle lockinghole 304 that includes at least one compression slot 306 that extendsalong the central longitudinal axis 308 of the bone plate 300. Thecompression slot 306 can be generally defined by an inner wall 312 thatextends through at least a portion of the bone plate 300. Further,opposing sides of the inner wall 312 of the compression slot 306 caneach include a compression ramp 314. The compression ramps 314 can beinwardly sloped or inclined in a general direction away from the topside 108 of the bone plate 300 as the compression ramps 314 extends awayfrom an end portion 316 of the compression slot 306.

As illustrated in FIG. 9C, a fixation element 128 (FIG. 4A) driven intoa bone 106 can at least initially be positioned in the compression slot306 such that the central longitudinal axis 148 of the fixation element128 is offset from the central axis 310 of the variable angle lockinghole 304. Similar to previously discussed embodiments, as the fixationelement 128 proceeds to be driven into the bone 106, a portion of thefixation element 128, such as the head portion 136 of the fixationelement 128, can be at least transversally displaced toward the boneplate 300 and come into contact with the compression ramps 314. Suchcontact of the fixation element 128 with the inclined or sloped surfaceof the compression ramps 314 can facilitate axial displacement such as,for example, sliding of the bone plate 300 in an axial direction (asindicated by the “A” direction in FIG. 9C) toward the centrallongitudinal axis 148 of the fixation element 128 and/or facilitateaxial displacement the bone 106 generally in a direction toward thecentral axis 310 of the variable angle locking hole 304. Morespecifically, such engagement between the fixation element 128 and thebone plate 300 can facilitate axial displacement of the bone plate 300and/or bone 106 such that the central longitudinal axis 148 of thefixation element 128 and the central axis 310 of the variable anglelocking hole 304 are generally aligned or in closer proximity to oneanother. Further, the extent to which the relative axial displacementthat can be attained to bring the central longitudinal axis 148 of thefixation element 128 and the central axis 310 of the variable anglelocking hole 304 into alignment or in closer proximity to one anothercan be influenced by the operable length of the compression slot 306,and by the possible initial distance (as indicated by “W” in FIG. 9C)between central longitudinal axis 148 of the fixation element 128 andthe central axis 310 of the variable angle locking hole 304.

FIGS. 10A and 10B illustrate another embodiment of a bone plate 400having a combination fixed-variable angle hole 402 that is adapted toengage a locking or non-locking fixation element and assist in theformation of axial compression or tension along the bone plate 400and/or bone 106. The bone plate 400 can be structured such that, incertain situations, at least one of the variable angle holes 402illustrated in FIGS. 10A and 10B can be positioned on one side of afracture site 104 to receive a locking screw such as, for example, alocking screw that has a thread on an outer surface of the head portion136 of the locking screw, while, on an opposite side of the fracturesite 104, at least one other combination fixed-variable angle hole 402receives either a locking or non-locking screw and/or the previouslydiscussed variable angle holes 102, 162, 202, 222, 252, 304 receives anon-locking fixation element.

According to certain embodiments, the combination fixed-variable anglehole 402 of FIGS. 10A and 10B is structured to at least assist in thelocking screw exerting a compressive force against the bone 106, while,for example, also retaining the position of the locking screw in thefixed-variable angle hole 402 as the engagement between the non-lockingscrew and the associated variable angle hole 102, 162, 202, 222, 252,304 facilitates the formation of axial compressive or tensile forcesabout the bone plate 400 and/or the bone 106, as previously discussed.For example, according to certain embodiments, the fixed-variable anglehole 402 can be structured such that the locking screw engages thecombination fixed-variable angle hole 402 in a manner that prevents thelocking screw from being pulled out of the bone 106 as a non-lockingscrew on an opposite side of the fracture site 104 that is being driveninto the bone 106 operably engages with a wedge wall 120, 174, 208, 254or compression ramps 264 a, 264 b of the variable angle hole 102, 162,202, 222, 252, 304, as previously discussed. Moreover, the combinationfixed-variable angle hole 402 can be sized so as to prevent or limitmovement of the combination fixed-variable angle hole 402 relative tothe locking screw as engagement of the non-locking screw with the wedgewall 120, 174, 208, 254 or compression ramps 264 a, 264 b on theopposite side of the fracture site 104 generates forces that can axiallydisplace or deform the bone plate 400 and/or bone 106.

According to the illustrated embodiment, the combination fixed-variableangle hole 402 includes an inner wall 404 that generally defines anorifice 406 of the fixed-variable angle hole 402. The orifice 406 can besized to accommodate passage of a portion of the fixation element suchas, for example, a threaded or non-threaded shank portion 134, throughthe fixed-variable angle hole 402. Further, the orifice 406 can be sizedsuch that the fixation element fixation generally does not extend beyonda top side 408 of the bone plate 400. For example, referencing FIGS. 3,10A, and 10B, the orifice 406 can be sized such that the head portion136 of the first fixation element 128 a that can be positioned in thecombination fixed-variable angle hole 402 is generally recessed below,or relatively flush with, the top side 408 of the bone plate 400.

As illustrated in FIGS. 10A and 10B, the fixed-variable angle hole 402can include a plurality of tabs 410 that inwardly extend from the innerwall 404, and which are separated from adjacent tabs 410 by a recess412. The tabs 410 can be sized such that a portion of the fixationelement can, in at least certain embodiment, including but not limitedto when the fixation element is a non-locking screw, securely engage oneor more of the tabs 410. Further, the tabs 410 can be sized to provideinterference that prevents at least a portion of the fixation elementsuch as, for example, a head portion 136, from being pulled through theentire orifice 406. Further, the recesses 412 can accommodate at leastthe angular positioning of the fixation element into the variable angleholes 402 such as, for example, a locking or non-locking screw passinginto the fixed-variable angle hole 402 at an angle that is non-parallelto a central axis 414 of the fixed-variable angle hole 402. Further,according to certain embodiments, two or more of the recesses 412, andthus two or more of the tabs 410, can have different sizes such as, forexample, different widths, than other tabs 410 and recesses 412. Forexample, according to some embodiments, the recesses 412 that arepositioned generally along a longitudinal axis 415 of the bone plate 400can provide a larger space between adjacent tabs 410 than is provided byother recesses 412. Additionally, while the variable angle holes 402 canbe structured to provide a variety of different number tabs 410 andassociated recesses 412, according to the illustrated embodiment, thefixed-variable angle hole 402 has six recesses 412.

The combination fixed-variable angle hole 402 further includes aplurality of projections 416 that inwardly extend from the inner wall404, and which are positioned between the tabs 410 and a top side 408 ofthe bone plate 400. According to certain embodiments, the pluralityprojections 416 can matingly engage the fixation element in a mannerthat can at least assist in lockingly securing the fixation element tothe bone plate 106 and/or compressing the bone plate 400 against thebone 106. Additionally, according to certain embodiments, the pluralityof projections 416 can provide a thread that mates with a threadedportion of a head portion 136 of the fixation element such as, forexample, a threaded portion of the head portion 136 of a locking screw.For example, referring to FIGS. 3, 10A and 10B, in at least certainembodiments, the fixation element can be a locking screw and can beoperably secured in the combination fixed-variable angle hole 402 suchthat the central longitudinal axis 148 a of the fixation element isgenerally aligned and/or parallel with the central axis 414 of thefixed-variable angle hole 402. In such situations, threads on the outersurface of the head portion 138 of the locking screw can threadinglyengage the thread provided by the plurality of projections 416 of thefixed-variable angle hole 402. Alternatively, as discussed above, thefixed-variable angle hole 402, including the recesses 412 and tabs 410,can be configured such that a fixation element, which can be a lockingor non-locking screw, can be operably positioned in the fixed-variableangle hole 402 at a variety of different angles that are not parallel tothe central axis 414 of the fixed-variable angle hole 402. In suchsituations, the threads of the locking screw can still engage or abutthe projections 416 in a non-threaded manner without subsequentprocedures to build-up of the head portion 136 of the locking screw.Additionally, in at least certain embodiments, such non-threadedengagement of the plurality of projections 416 with the locking screw,or alternatively a non-locking screw, can assist in retaining theposition of the fixation element and/or the fixed-variable angle hole402 while the bone plate 400 and/or bone 106 is subjected to axialcompression or distraction by engagement of another fixation device witha wedge wall 120, 174, 208, 254 or compression ramps 264 a, 264 b of thevariable angle hole 102, 162, 202, 222, 252, 304, as previouslydiscussed.

While the invention has been described in connection with what ispresently considered to be the most practical and preferred embodiment,it is to be understood that the invention is not to be limited to thedisclosed embodiment(s), but on the contrary, is intended to covervarious modifications and equivalent arrangements included within thespirit and scope of the appended claims, which scope is to be accordedthe broadest interpretation so as to encompass all such modificationsand equivalent structures as permitted under the law.

It should be understood that while the use of the word preferable,preferably, or preferred in the description above indicates that featureso described may be more desirable, it nonetheless may not be necessaryand any embodiment lacking the same may be contemplated as within thescope of the invention, that scope being defined by the claims thatfollow. In reading the claims it is intended that when words such as“a,” “an,” “at least one” and “at least a portion” are used, there is nointention to limit the claim to only one item unless specifically statedto the contrary in the claim. Further, when the language “at least aportion” and/or “a portion” is used the item may include a portionand/or the entire item unless specifically stated to the contrary.

1. A bone plate configured to receive at least one fixation element tosecure the bone plate to at least one bone segment, the bone platecomprising: a first end and a second end, the bone plate extendingaxially between the first and second ends along a central longitudinalaxis of the bone plate; and an elongated variable angle hole including alength extending a first distance as measured along the centrallongitudinal axis and a width having a second distance as measuredperpendicular to the central longitudinal axis, the first distance beinggreater than the second distance, the elongated variable angle holefurther including: a plurality of inwardly extending tabs on each sideof the central longitudinal axis extending and spaced circumferentiallyabout the variable angle hole, the plurality of inwardly extending tabsincluding first and second layers of tabs, the first layer of tabs beingpositioned in closer proximity to a top surface of the bone plate thanthe second layer of tabs, each tab in the first layer of tabs beingcircumferentially separated from adjacent tabs in the first layer oftabs by a recess, each tab in the second layer of tabs beingcircumferentially separated from adjacent tabs in the second layer oftabs by a recess, the plurality of inwardly extending tabs beingarranged and configured to engage threads formed on a head portion ofthe at least one fixation element for securing a position of the atleast one fixation element relative to the bone plate; wherein all ofthe tabs in the first layer of tabs are circumferentially offsetrelative to all of the tabs in the second layer of tabs.
 2. The boneplate of claim 1, wherein the second layer of tabs includes two tabs. 3.The bone plate of claim 2, wherein the first layer of tabs includes asame number of tabs as the second layer of tabs.
 4. The bone plate ofclaim 2, wherein the first layer of tabs includes a different number oftabs as the second layer of tabs.
 5. The bone plate of claim 1, whereinthe second layer of tabs consists of first and second tabs.
 6. The boneplate of claim 5, wherein the first layer of tabs includes a same numberof tabs as the second layer of tabs.
 7. The bone plate of claim 5,wherein the first layer of tabs includes a different number of tabs asthe second layer of tabs.
 8. The bone plate of claim 7, wherein thefirst layer of tabs consists of first, second, third, and fourth tabs.9. The bone plate of claim 1, wherein the first layer of tabs includes aplurality of inwardly extending tabs and the second layer of tabsincludes a plurality of inwardly extending tabs.
 10. The bone plate ofclaim 9, wherein the plurality of tabs in the first layer arerotationally offset relative to the plurality of tabs in the secondlayer.
 11. The bone plate of claim 9, wherein the first layer of tabsinclude a greater number of tabs than the second layer of tabs.
 12. Thebone plate of claim 1, wherein the elongated variable angle hole furtherincludes at least one axial offset recess sized and configured toreceive insertion of at least a portion of the at least one fixationelement at a location in the variable angle hole at which a central axisof the received fixation element is axially offset by an offset distancefrom a central axis of the variable angle hole.
 13. The bone plate ofclaim 12, wherein the at least one axial offset recess includes a firstaxial offset recess and a second axial offset recess, the first andsecond axial offset recesses extending in opposite directions along thecentral longitudinal axis of the bone plate.
 14. The bone plate of claim12, wherein the elongated variable angle hole further includes a wedgewall having a shape sized and configured to be engaged by at least aportion of the received fixation element to axially displace the boneplate and the received fixation element relative to each other inopposite directions that decreases the offset distance between thecentral axis of the received fixation element and the central axis ofthe at least one variable angle hole.
 15. The bone plate of claim 14,wherein the wedge wall further includes a compression ramp positionedabout the at least one axial offset recess.
 16. The bone plate of claim15, wherein the compression ramp comprises a recess in the wedge wall,the recess having a size structured to mate with at least a portion ofthe received fixation element.
 17. A bone plate configured to receive atleast one fixation element to secure the bone plate to at least one bonesegment, the bone plate comprising: a first end and a second end, thebone plate extending axially between the first and second ends along acentral longitudinal axis of the bone plate; and an elongated variableangle hole including a length extending a first distance as measuredalong the central longitudinal axis and a width having a second distanceas measured perpendicular to the central longitudinal axis, the firstdistance being greater than the second distance, the elongated variableangle hole further including: a first layer of inwardly extending tabs;and a second layer of inwardly extending tabs, the first layer ofinwardly extending tabs being positioned in closer proximity to a topsurface of the bone plate than the second layer of inwardly extendingtabs; wherein: the second layer of inwardly extending tabs includesfirst and second tabs, the first tab being circumferentially separatedfrom the second tab by a recess; the first layer of inwardly extendingtabs includes a same number of tabs as the second layer of inwardlyextending tabs, the tabs being circumferentially separated by a recess;each tab in the first and second layer of tabs being arranged andconfigured to engage threads formed on a head portion of the at leastone fixation element for securing a position of the at least onefixation element relative to the bone plate; and all of the tabs in thefirst layer of tabs are circumferentially offset relative to all of thetabs in the second layer of tabs.